Healthcare Provider Details

I. General information

NPI: 1922406347
Provider Name (Legal Business Name): TXO CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 CRESCENT ST
ASTORIA NY
11102-4370
US

IV. Provider business mailing address

1078 DOBBS FERRY RD
WHITE PLAINS NY
10607-2209
US

V. Phone/Fax

Practice location:
  • Phone: 765-360-9078
  • Fax: 914-909-4520
Mailing address:
  • Phone: 914-310-9078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX011863
License Number StateNY

VIII. Authorized Official

Name: THEODORE XENOS
Title or Position: PRESIDENT
Credential:
Phone: 914-310-9078